1. Gigantic
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    Gigantic New Member

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    Therapy/Medication and UK Criminal Law.

    Discussion in 'Research' started by Gigantic, Aug 30, 2013.

    Good evening,

    I'm in the early stages of my novel, and intend on gathering some factual information on the UK medical and criminal law system. I've had no success with posting my questions on public law forums, as they'd rather only focus their time on people posting with real problems. If only they knew the mental anguish of writing.
    The main character of the story is dealing with the conflict of the antagonist being released from prison after the manslaughter of the MC's girlfriend which happened in the previous year. These characters are all a part of Glasgow's poverty stricken schemes, with the antagonist having acted out his crime under the influence of drugs during a mugging gone wrong. Due to this event, it's left the MC a broken man. I'm playing with the idea of having the MC featuring in a weekly therapy session.

    So my questions on therapy and medication are:

    • I'm aware the NHS offer free therapy sessions, but is there a limited number of times a patient can use this system? Is it likely someone would still be in (or, need) therapy after near enough twelve months of weekly sessions? Would the medical system still allow this to be free, or expect to charge the patient?
    • The MC will be on powerful anti-depressants to help him cope with the pain of his loss. He is also prone to anxiety attacks. Can I have confirmation on the name of what would be the most suitable prescribed drugs and dosage for depression and anxiety. And if anyone has had any experience on them - how beneficial they are and the effects they felt when coming off them.
    • Is there such a prescribed drug that would help someone forget/blur out the unfortunate reality of such an incident? I'm aware this is more into the realm of fiction as it's something I've never heard of, and I'd rather steer clear of inventing some wonder potion. But if anyone knows, I'd appreciate any information.
    And my questions on criminal law are:

    • If someone was to commit manslaughter under the influence of drugs during a robbing gone wrong, are there any loopholes in the system which would have the person out of prison within a year? My understanding on what I've read up on so far is that manslaughter still carries a life sentence - but tabloids are full of drunk drivers being home after only a year behind bars, and child killers getting out - not even serving the full sentence given.
    The crime committed was that the antagonist stabbed the girl while she fought back during his attempts to steal from her. The knife was only pulled out to strike fear.

    I have researched this on my own, but as mentioned I've hit a few dead ends with people in these professional fields not being overly helpful. I'd also appreciate to know if any members on here have researched and included any of the above in their own writing. Thanks.
     
  2. jazzabel
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    jazzabel Contributing Member Contributor

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    1. The usual in the NHS (this refers to the general practice patients) is a referral to MIND for 12 sessions with a psychologist or a councillor. This might be extended, if necessary, but not by much. The price is symbolic, something like £10 per session. There may be a counselling scheme for the victims of violence through the police, but this has been changing over the years. The sessions are usually once per week, and they are unlikely to last for a year. But there are psychologists who offer sliding scale pricing system, so at a stretch, you can have your MC be in therapy with a student psychologist or someone very altruistic.

    2. Well, the most likely first line would be Sertraline (Zoloft). Provided that it was dosed correctly (start low, go slow) and that the patient didn't suffer early side-effects, the main effects will be on his libido (low, anorgasmia) and sometimes feeling like he is numbed, fuzzy-headed, that sort of thing. Appetite may be also suppressed somewhat. But if he is profoundly anxious, Citalopram might be a better option. All the SSRIs have similar side-effects, and the effectiveness is individual. If this doesn't work (depression-wise) the next line is probably Effexor (venlafaxine) which is more potent but will also be more likely to cause side-effects, it can elevate mood, make patient irritable or even give rise to seizures. Another is Paroxetine, which seems to suit some people really well, but has higher suicidality risk than others in the same group. From here, treatment becomes more serious, with tricyclics (pronounced antimuscarinic side effects and high mortality in overdose), which then may be potentiated with Lithium (narrow therapeutic range, thyroid suppression, seizures), or MAO inhibitors (dietary restrictions and long wash-out period if want to switch back to the SSRIs).

    Anxiety-wise, if it's acute, variety of medicines may help. On one hand are benzodiazepines such as temazepam (for sleep), diazepam (long acting) or something like oxazepam (intermediate acting, dose twice or three times per day) but these have many side-effects (sedation, increase in post-traumatic symptoms, addiction), but also drugs like Propranolol (beta antagonist used to lower blood pressure and heart rate, which can work well but is contraindicated in patients with asthma) or Buspar (less addictive than benzos). Both benzos and Buspar need to be stopped slowly, as do SSRI's because if they are suddenly withdrawn, can give rise to withdrawal symptoms. Withdrawal usually causes palpitations,anxiety,insomnia but also hallucinations, diarrhoea, vomiting, headaches etc.

    3. Actually, recent studies showed that if the survivors of trauma are given benzos (diazepam) immediately after the event, they suffered less post-traumatic symptoms than people who were allowed to process the trauma cognitively in more detail and form stable traumatic memories. I imagine midazolam, which sedates you completely without knocking off the breathing, just might blur out the memory (or most of it). However, it's been shown that the body remembers the trauma even if the brain doesn't, so rape or other physical trauma may be remembered by body parts that suffered, which in turn may give rise to specific symptoms or even illnesses if the trauma was not available to the consciousness (was effectivelly being suppressed).

    4. You need to read up on McNaughton rules and insanity defence ( all available on Wiki and numerous sources easily found on Google). The basics are, the person must, at the time of committing the act, have a) disease of the mind, b) must have not known the nature or quality of their actions and c) did not know what they were doing was wrong. Drugs and alcohol , if administered voluntarily by the offender, do not qualify for insanity defence. Disease of the mind usually implies some form of psychosis, but people with specific types of epilepsy and other brain pathology sometimes qualify, if it can be proven that they committed an act during an episode of automatic behaviour, or a fugue state and the like.

    People who satisfy the insanity defence are usually found not fit to stand trial. They are placed in forensic psych institutions and reviewed on regular basis. A bipolar guy who robbed a bank and didn't kill anyone, and is now well on medication, might come out after a year or two. But he will remain a forensic outpatient for a lot longer. A schizophrenic guy who shot his neighbour because he thought he was CIA will most definitely not be released as easily, even if well. It's unlikely anyone would be released due to a 'loophole' because the offender must be assessed by Mental Health Review Board which consists of several people (lawyers,doctors, lay people) who would all have toconspire together with the treating psychiatrist. But in fiction, nothing is impossible. Most such inmates I knew were in hospital on a very long-term basis, proportional to their dangerousness level, as assessed by their prior crimes and ongoing symptomatology. And then there are seriously disturbed one, such as Brady, who will never get out.

    Drunk-drivers who were out after a year are a failure of the legal system. Involuntary manslaughter usually gets shockingly short punishments, they aren't connected with forensic psych system in any way (because intoxication doesn't count as 'disease of the mind') so they get 4 years, out in 18 months type deal from the CPS.

    The crime being committed during robbery will be viewed as murder (most likely), mitigating circumstances will be few, he will not get the highest punishment as it wasn't premeditated, strictly speaking, but he carried a deadly weapon, thus he is responsible. It really depends on the lawyer and the judge, but I'd imagine something like 7-10 years, out in 3-6 depending on many factors, including good behaviour and prison overcrowding.

    I hope this helps, but feel free to ask if you have other questions. I have a background in forensic psychiatry, not so well versed in law, but I've seen enough to make an educated guess.
     

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